The association between psychosocial working conditions and the quality of delivered patient care: a prospective study among medical assistants

背景：卫生保健部门的工作条件一直被描述为情绪要求很高。这种恶劣的社会心理工作条件不仅是卫生保健人员健康和工作能力的风险因素，而且还与提供较差的病人护理有关(例如，差错率增加)。这种关系在护士和医生中被反复记录下来。然而，到目前为止，医疗助理(MA)受到的关注很少，尽管他们代表了门诊护理中最大的专业人群，ii)经历了情感负担沉重的工作条件，以及iii)执行与患者护理相关的大量任务。目的：总体目标是调查MA中心理社会工作条件与提供患者护理质量之间的潜在联系。这一设想的项目将在以下方面做出新的贡献：1)考虑各种类型的患者护理质量指标；2)前瞻性数据的利用；3)基于理论的解释机制检验。方法：2016年末，申请者共调查了944名MA。这一人群将在2019年底进行跟踪调查。心理社会工作条件(即暴露)将通过一个既定的工具(即努力-回报不平衡问卷)和专门为MA设计的问卷来衡量，其中包括衡量MA主管的工作要求、合作、执业组织和特征。护理质量将通过对已犯下的重大医疗错误、文件错误和与患者的社会互动质量(即结果)的问题进行评估。根据理论模型确定的潜在中介因素包括，例如工作满意度差和精神健康受损。前瞻性关系将通过多变量二项回归模型(针对二分结果)和线性回归(即，针对连续结果的改变分数)进行检验。潜在的调解将通过“差异法”进行评估。影响：基于预期数据和理论模型，这项设想的研究将提供关于潜在关联和解释机制的证据。这些见解可能有助于制定工作场所干预措施，以改善MA的工作条件，从而提高他们提供的护理质量。

Background: Working conditions in the health care sector have been characterized as emotionally demanding. Such poor psychosocial working conditions represent not only a risk factor for the health and workability of health care staff, but are also associated with the delivery of poorer patient care (e.g., increased rates of errors). This relationship has repeatedly been documented among nurses and physicians. Medical assistants (MAs) have however received very little attention to date despite the fact that they i) represent the largest professional population in outpatient care, ii) experience emotionally taxing working conditions, and iii) perform a large range of tasks that are relevant to patient care.Objective: The overarching objective is to examine the potential associations between psychosocial working conditions and the quality of delivered patient care among MAs. The envisioned project will specifically make novel contributions by i) considering various types of quality indicators of patient care, ii) the utilization of prospective data and iii) theory-based examination of explanatory mechanisms.Methods: In late 2016, a total of 944 MAs were surveyed („baseline“) by the applicant. This population will be followed-up in late 2019. Psychosocial working conditions (i.e., the exposures) will be measured by an established instrument (i.e. the effort-reward imbalance questionnaire) and a questionnaire specifically designed for MAs, which measures, amongst others, job demands, cooperation, practice organization and characteristics of MAs’ supervisors. Quality of care will be assessed by questions on major medical errors that have been made, on documentation errors and on the quality of the social interaction with patients (i.e., the outcomes). Potential mediators, which were identified based on a theoretical model, include for instance a poor job satisfaction and impaired mental health. Prospective relationships will be examined by multivariable binomial regressions models (for dichotomous outcomes) and linear regression (i.e. change score for continuous outcomes). Potential mediation will be assessed by the “difference method“.Implications: Based on prospective data and a theoretical model the envisioned study will provide evidence on potential associations and explanatory mechanisms. These insights may inform the development of workplace interventions to improve MAs’ working conditions and thereby the quality of care they provide.